Provider Demographics
NPI:1093560997
Name:MAGIC CHINESE MEDICINE LLC
Entity type:Organization
Organization Name:MAGIC CHINESE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:210-214-0729
Mailing Address - Street 1:19002 GENTLE KNL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3415
Mailing Address - Country:US
Mailing Address - Phone:210-214-0729
Mailing Address - Fax:210-664-7399
Practice Address - Street 1:18756 STONE OAK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4354
Practice Address - Country:US
Practice Address - Phone:210-214-0729
Practice Address - Fax:210-664-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty